Subtypes of Identity Disturbance and Their Association with the Course of Borderline Personality Disorder Over 16 Years of Prospective Follow-up

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Identity disturbance is often described as a core symptom of psychopathology in borderline personality disorder (BPD), a mental illness characterized by severe abandonment and interpersonal issues. The following study had two objectives. The first was to determine if identity disturbances (no identity, internal badness, and suffering identity) are more pronounced in BPD patients compared to axis II comparison participants over 16 years. The second was to determine whether or not the course of recovery in borderline patients (i.e.. concurrent symptomatic remission and good psychosocial functioning) is influenced by a specific identity disturbance subtype (no identity, suffering, or internal badness). Identity disturbance was reassessed every 2 years using 13 items from the Dysphoric Affect Scale (DAS), which is a self report of 50 items that describes dysphonic inner states (affective and cognitive states) found to be common and/or discriminating for BPD. From the 13 items, each was separated into identity disturbance subtype and an aggregate of scores was calculated. Results revealed identity disturbances were larger in BPD patients as compared to axis II comparison group. All forms of identity disturbance predicted two year recovery in bivariate analysis; however, only identity with a sense of badness predicted significantly slower time than 2-year recovery. Taken together, the results suggest subtypes of identity disturbance exist among BPD patients, are more strongly endorsed in BPD patients than in axis 11 comparison participants, and are associated with different courses of the disorder.